The Simply Dinner Study: Preventing Childhood Obesity

Brittany Motz, Mara Stein, and Emily DiGiovanni prepare a meal for delivery. This menu has baked apples as the fruit/dessert portion of the meal.

Nearly 25 percent of American preschool-aged children are overweight or obese, a condition that can lead to all sorts of health issues later in life. Over the past few years, obesity prevention strategies have zeroed in on family mealtimes as an opportunity to improve dietary quality. Several studies have confirmed the modest effectiveness of programs like classes on meal planning and preparation to help parents gain the skills to feed their families wisely.

However, that's not the end of the story. Holly Brophy-Herb of MSU's Department of Human Development and Family Studies, whose team has conducted many of these studies, noticed that too little attention was being paid to the difficulties some families face when trying to carry out recommended changes. "Many programs don't address the practical resources that enable parents to implement family meals," she said. "There is a striking lack of evidence about what level of resources that parents, especially low-income parents, need to do this."

Addressing Barriers to Change

Accordingly, Brophy-Herb and her research team (see list of partners at end of article) set out to determine what supports might be most helpful to low-income families, who often face a number of stressors that make implementing family meals more challenging. Beginning with barriers to family meals that had been reported by participants in other studies—such as limited time for meal preparation and challenges with cooking—she and the team developed a list of six interventions that seemed most likely to address these problems effectively, and a plan to test them.

From most to least intensive, the interventions are: (1) home delivery of pre-made meals (most intensive assistance); (2) home delivery of healthy-meal ingredients; (3) community kitchens where parents can put together nutritious ingredients with recipes to cook at home; (4) healthy eating classes; (5) cooking demonstrations; and (6) home delivery of cookware and flatware (least intensive assistance). Recipes are included with all activities except cookware delivery.

The Simply Dinner Study: Phase 1

In collaboration with two Head Start partner programs (at Capital Area Community Services [CACS] and the Community Action Agency [CAA], both in Michigan), the team recruited families to participate in the study. The Head Start community partners also helped to develop and review recipes for the interventions. "The parents enjoyed all aspects of the program, especially having the meals delivered," said Lucy McClintic, director of CACS Head Start. "They also liked the recipes. I was impressed that the group stayed together for cooking lessons over the grant period."

Elizabeth McClain, director of program development and evaluation manager at CAA, added, "This program helps our program families receive nutritious meals. In addition it allows families to try new things that they typically would not, being on a restricted budget. Families also learn about how to properly prepare food and about food safety. Families that have participated have all truly enjoyed being in the study."

MSU Extension educators with training in health and nutrition, including a registered dietician, delivered the community kitchen, healthy eating classes, and cooking demonstration components (interventions 3-5) of the study.

Mildred Horodynski, professor emeritus with the College of Nursing and a coprincipal investigator on the study, said that one intent of the project is to provide a model for community participation concerning a highly significant problem.

The interventions ran for five cycles, each eight weeks long, during academic year 2016-2017. The last cycle will be finished in fall 2017. Outcomes of interest in Phase 1 of the study are the frequency of family meals and dietary quality. The team also wants to evaluate participants' use of and satisfaction with the supports offered.

At the end of the fifth cycle, in December 2017, they will test the main, additive, and interactive effects of the intervention components to determine which components or combinations of components are associated most robustly with outcomes.

Then the real fun begins.

Multiplying Successes: Phase 2

The intervention components or combinations of components from Phase 1 that show the most promise for success will be bundled into a more complex intervention package for further testing in Phase 2, which begins in spring 2018. Decisions about what to include in the "best of" bundle will be made using a relatively new approach known as the Multiple Optimization Strategy (MOST).

The MOST experimental design maximizes the statistical power to estimate the effects of each program component separately, as well as interactions between the components. However, said Brophy-Herb, "Decisions will not always be based purely on statistical significance or effect size. We will also examine cost. Some components, like meal delivery, are quite expensive. In order to justify including them in the bundled intervention, we will require them to have a larger effect size relative to cost."

Phase 2 will ask the question: Will receiving these optimized supports contribute to improved body mass index (BMI) for children? The researchers will also mine their data for insights about various other secondary effects.

Brophy-Herb believes that the Simply Dinner study will provide important information about the types of interventions that are most closely associated with improving children's dietary quality and obesity indices. "Policy makers will have a better basis for deciding where to allocate limited resources for the greatest benefit," she said.